Preventive Drugs Continued at End of Life Have Many Unnecessary Costs

​​By staff

Stockholm, Sweden—Discontinuing preventive medications for advanced cancer patients can reduce unnecessary side effects, improve quality of life. and lessen financial burdens, according to a new study.

A new study published early by Cancer, a peer-reviewed journal of the American Cancer Society, suggests that medications such as those designed to lower blood pressure or cholesterol, or to protect bone health often aren’t deprescribed during the last year of life of older adults with cancer.

Karolinska Institute researchers point out that continuation of preventive drugs among older patients with advanced cancer is being scrutinized because the drugs are unlikely to achieve their clinical benefit during the patients’ remaining lifespan.

To quantify the burden, the study team conducted a Swedish nationwide cohort study of adults aged 65 years and older with solid tumors who died between 2007 and 2013. The monthly use and cost of preventive drugs throughout the last year before the patients’ death was calculated.

Results indicate that, among 151,201 older patients who died with cancer, at a mean age of 81.3 years, the average number of drugs increased from 6.9 to 10.1 over the course of the last year before death. Researchers determined that preventive drugs frequently were continued until the final month of life, including antihypertensives, platelet aggregation inhibitors, anticoagulants, statins, and oral antidiabetics.

The researchers also documented that median drug costs were $1,482 (interquartile range [IQR], $700-$2,896]) per person, including $213 (IQR, $77-$490) for preventive therapies.

Costs were not the same for every diagnosis, however. Compared with older adults who died with lung cancer (median drug cost, $205; IQR, $61-$523), the study team demonstrated that costs for preventive drugs were higher among older adults who died with pancreatic cancer (adjusted median difference, $13; 95% CI, $5-$22) or gynecological cancers (adjusted median difference, $27; 95% CI, $18-$36). No decrease in preventive drugs throughout the last year of life was found.

“Preventive drugs commonly are prescribed during the last year of life among older adults with cancer, and often are continued until the final weeks before death,” the study authors concluded. “Adequate deprescribing strategies are warranted to reduce the burden of drugs with limited clinical benefit near the end of life.”

“Although the preventive drugs reported in our study are most often pharmacologically and clinically appropriate in the general population, their use in the context of limited life expectancy and palliative goals of care should be examined critically,” said lead author Lucas Morin. “Our finding that older adults with poor-prognosis cancers—including cancers of the brain, lung, liver, and pancreas—were just as likely as those with less aggressive disease to use preventive drugs during their last month of life suggests that there is room for deprescribing.”